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Only 50% of rabbits survive 90 min hepatic ischemia in spite of decompression of the gut. The remainder die within 36 h after operation. A single application of fibronectin before hepatic ischemia delays death for only a few hours. However, three postischemic applications of fibronectin--immediately after operation and 5 h and 24 h later--are associated with a statistically significant rise in the survival rate. Analysis of the transaminases indicates that fibronectin obviously limits the extent of ischemic liver cell necrosis. Of major significance is the fact that fibronectin supplement enables the RES of the liver to improve its phagocytic capacity, as shown by the RES clearance test. The presented experimental model shows that the liver with its RES, located between the splanchnic and the systemic circulation, is of particular significance for the entire organism. Hepatic ischemia or shock, independent of the initial cause, leads to significant reduction of hepatic phagocytosis. The results indicate that substitution of opsonins supports the phagocytic capacity.

An infant case of erythrophagocytic lymphohistiocytosis is reported. The disease began at the age of two months with hepatosplenomegaly and intractable fever, and later developed pancytopenia. Splenectomy had to be performed at the age of six months and led to the final diagnosis. After the age of nine months the patient developed progressive neurological signs (loss of visual function convulsions, opisthotonus and CSF pleocytosis). The changes in the CT-scan of the brain were explained by the neuropathologic findings after the death of the patient at the age of 13 months. The markedly atrophic brain showed diffuse and mainly perivascular infiltration of brain and meninges with lympho- and histiocytes and extensive microscopic calcification.

After splenectomy the immunologic impairment and the susceptibility to infection is increased, but the most important impetus for splenic preservation has been the observation of the overwhelming postsplenectomy sepsis. Successful results with surgical repair of traumatized spleen and several different techniques have been reported. Instead of suture of splenorrhaphy we used in our experiences a new biological adhesive-system, consisting in thrombin, highly concentrated native human fibrinogen and clotting factor XIII. The highly adhesive properties, the excellent tissue compatibility and the haemostyptic effects recommend this system for using in preservation of the injured spleen as well as possible.